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Reports from the Policy Front

December 4, 2017

by:

Doris Parfaite-Claude, Government Relations Manager

ANCOR's Government Relations staff distributes stories in the Washington Insiders Club (WICS) – a weekly round-up of top stories and headlines – to ANCOR Members to keep them up to date on policy and political developments of note to the disability community. The following entries highlight the most significant reports of the last two months.

December 4, 2017 – Early Saturday morning, the Senate passed the Tax Cuts and Jobs Act by a vote of 51-49. Sen. Bob Corker (R-TN) was the only Republican to vote against the tax bill citing deficit concerns. On Friday the non-partisan Joint Committee on Taxation reported that the legislation would increase the federal deficit by $1 trillion over ten years even accounting for robust economic growth. To learn more about the events overnight, click here to read a helpful rundown provided by The Hill.

Theoretically the House and Senate will now create a conference committee to reconcile the differences in each passed version of the legislation – Republican leaders suggest they are not that far apart (although do note items like the medical expense tax deduction are removed in the House bill, not in the Senate bill, etc.). That compromise bill would then go to both chambers for a straight up or down vote. However, we are hearing that the House has scheduled a vote for Monday evening to vote on the Senate bill as written. As with everything, this could change quickly and dramatically by Monday. Whatever the route to House passage, leadership in both chambers is working toward a final passed bill by Friday, December 8th. That bill would then be sent to President Trump for his signature.

December 4, 2017 – With the December 8 deadline looming for a government shutdown (the FY18 continuing resolution funding the government right now expires then), Senate Majority Leader Mitch McConnell shared on Sunday that he does not believe there will be a shutdown. He also added that contentious issues like the Deferred Action for Childhood Arrivals (DACA) immigration program will not hold up a budget deal because the President has given Congress until March to figure out a solution on that issue. Read more here on McConnell’s position. Earlier last week, Minority Senate Leader Chuck Schumer (D-NY) and Minority House Leader Nancy Pelosi (D-CA) refused to show up to a meeting with President Trump and GOP Congressional leadership. Despite the falling apart of these talks, Senator King (I-ME) who caucuses with the Democrats, has said that neither side wants to see a shutdown.

November 27, 2017 – The current continuing resolution funding the government for Fiscal Year 2018 expires on December 8, 2017. With the expiration date nearing, attention in Washington, DC has turned to the budget discussions. President Trump is meeting with Democratic and Republican Congressional leadership on Tuesday to discuss options moving forward. Issues complicating a deal include including addressing the Deferred Action for Childhood Arrivals (DACA) program and defense level spending.

November 20, 2017 – On November 13, 2017 President Trump announced the nomination of Mr. Alex Azar for Secretary of Health and Human Services (HHS). The Senate Health Education Labor and Pensions (HELP) Committee will hold a hearing on his nomination on November 29 – this link will show live video at that time. The HELP Committee hearing is a courtesy hearing; the Committee that votes on his nomination, the Senate Finance Committee, has yet to schedule their hearing.

Please see below for insights on Alex Azar from ANCOR’s lobbyists at ML Strategies:

“Azar, 50, began his career in Washington as a law clerk for former Supreme Court Justice Antonin Scalia before moving to the Office of the Independent Counsel under Ken Starr during the Whitewater investigation in 1994. He joined the Department of Health and Human Services (HHS) in August 2001 as General Counsel, serving in that role until 2005. During his time as General Counsel, he worked with the Department to declare and implement the first public health service emergency in response to the September 11th attacks. He was also involved in the development and implementation of the Medicare Part D prescription drug benefit.

When he became Deputy Secretary of HHS under Secretary Mike Leavitt, he was tasked with overseeing the department’s regulatory process, an area of health care where he has received high marks for his knowledge and experience. Azar left HHS in early 2007 to join Eli Lilly and Company as a Senior Vice President of Corporate Affairs and Communications, and ultimately became President of Lilly USA, the largest subsidiary of Eli Lilly and Company, serving as President for five years until January 2017. With its corporate headquarters in Indiana, Azar has a connection to Vice President Mike Pence as Governor and CMS Administrator Seema Verma, who helped develop the Healthy Indiana Plan.

Azar founded his own consulting firm, Seraphim Strategies, this year. Seraphim Strategies provides services surrounding the biopharmaceutical and health insurance industries, specifically biopharmaceutical sales, marketing, reimbursement, access, and distribution as it relates to federal and state health care policy.

We can expect a significant shift in policy direction as we move from Secretary Price to Secretary Azar. Price, an orthopedic surgeon, had the goal and mission to take on the physician versus government’s role in health care delivery. Specifically, Price was looking for ways to reduce the burden to providers and limit any interference in doctors’ decision making abilities. Although we do not know Azar’s exact objectives for HHS, it is fairly certain that he does not have the same mission as Price. Given his regulatory background, we could see added emphasis in such health care issues as MACRA implementation, electronic health records, the role of the Centers for Medicare and Medicaid Innovation (CMMI), and other areas which will carry significance both nationally and at the state level.

With Azar at the helm of HHS and Joe Grogan, the Associate Director of Health Policy Programs at OMB (another PhRMA alumni formerly of Amgen and Gilead), PhRMA is situated to be very well protected. However, it remains to be seen how PhRMA friendly the administration will become. Expectations of this administration being ‘mean’ to PhRMA should remain low. Despite the President’s tweets…

It remains unclear how significant staff turnover will be with this transition. Many of the health care political appointees were former Price staffers. While some may have relationships with Azar given his significant Washington experience, Azar may want to bring in staff of his own.”

ANCOR will inform members on issues and statements of interest which may arise during the nomination hearing once it has occurred.

November 13, 2017 – On November 7, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma shared her vision for Medicaid and steps she is taking to implement it with the National Association of Medicaid Directors (NAMD). ANCOR CEO Barbara Merrill and Senior Director of Government Relations Esme Grant Grewal heard the announcement live, and wish to bring your attention to the official press release announcing these steps, issued on the same day – click here.

ANCOR is awaiting additional details on these proposals and in the interim wanted to share additional context on Administrator Verma’s approach, which Politico’s Morning E-health newsletter flagged in an excerpt– we have copied it below for your convenience:

“SEEMA SAYS MEDICAID CAN BE A GOLDEN PRISON: CMS Administrator Seema Verma on Tuesday said the Obama administration had practiced "soft bigotry" by expanding Medicaid to "able-bodied adults," and promised to help more of them "move up, move on and move out" of the program. Medicaid expansion has jeopardized care for more vulnerable enrollees by stretching the safety net, she said. The program, which now covers roughly one in five Americans, has grown since 2014 to cover millions of additional low-income adults, most without children. More by Rachana Pradhan here.”